Premonitions of brain herniation, emergency treatment is required if symptoms are detected

The most obvious symptom of brain hernia is increased intracranial pressure. Patients may experience frequent vomiting, severe headaches, irritability, drowsiness, coma, movement disorders, etc. Timely treatment is required to avoid threats to life.

1. Transtentorial herniation

1. Symptoms of increased intracranial pressure: severe headache and frequent vomiting, which are more severe than before brain herniation, and irritability.

2. Changes in consciousness: manifested as drowsiness, light stupor or even coma, and slow or absent response to external stimuli.

3. Pupillary changes: The pupils on both sides are not of the same size. At the beginning, the pupil on the affected side is slightly constricted, and the light reaction is a little slow. Later, the pupil on the affected side gradually dilates and becomes slightly irregular. Direct and indirect light reactions disappear, but the pupil on the other side may still be normal. This is because the oculomotor nerve on the affected side is compressed and pulled. In addition, the affected side may also be in danger of ptosis and exotropia. If brain herniation continues to develop, bilateral pupils may dilate and light reactions disappear. This is caused by dysfunction of the oculomotor nerve nucleus in the brain stem due to compression.

4. Movement disorders: mostly occur on the opposite side of the dilated pupil, manifested as reduced or absent autonomous limb movement. The continued development of brain herniation causes the symptoms to spread to both sides, causing weakness in the limbs or intermittent head and neck tilt, limbs straight, back hyperextension, and opisthotonos, which is called decerebrate rigidity and is a characteristic manifestation of severe brainstem damage.

5. Disorder of vital signs: manifested as changes in blood pressure, pulse, respiration, and body temperature. In severe cases, blood pressure fluctuates, respiration speeds up and slows down, the face sometimes becomes flushed, and sweats profusely, and sometimes turns pale and sweats stop. The body temperature can be as high as 41°C or as low as 35°C without rising. Finally, breathing stops, blood pressure drops, and the heart stops beating, resulting in death.

2. Foramen magnum hernia:

Patients often only have severe headaches, repeated vomiting, disordered vital signs, stiff neck, pain, and changes in consciousness that occur later, without pupil changes, and respiratory arrest that occurs earlier.

3. Herniation below the falx cerebri:

It causes softening and necrosis of brain tissue in the compressed part of the medial surface of the affected cerebral hemisphere, resulting in symptoms such as mild paralysis of the contralateral lower limbs and urination disorders.